Caries Ebooks Catalog

Dentists Be Damned

This eBook teaches you all the remedies and tricks that you need to know to Never visit the dentist again, and still have the most perfect mouth full of the teeth that you know of. This book contains a toothache remedy that will treat the root of the problem, how to restore your gums to full health, a supplement that makes plaque fall off your teeth in no time, and a solution that can stop cavities Forever. This book doesn't just teach you how to get rid of some pain, it teaches you how to Eliminate the source of pain once and for all. After taking to heart the information in this book, trips to the dentist will become a thing of the past. Alice Barnes has taken her 15 years of tooth research and compiled it all in this eBook for you. And when you order, you get two free eBooks! You will also receive How to Prevent and Cure Canker Sores, and How to Get Rid of Bad Breath. All of these resources will keep you OUT of dentists' offices as long as you live! Read more...

Dentists Be Damned Summary


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Author: Alice Barnes
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Highly Recommended

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Total Dental Health

Total Dental Health is a natural program aimed at preventing and reversing severe periodontal disease. Total Dental Health was created with the aim of ensuring people get healthy within a few days. It is an E-book that has a comprehensive, natural and easy plan to ward off periodontitis as well as fight it. Total Dental Health was designed to help people by pointing out methods that will be useful in having a great oral health. The plan is so comprehensive that the users will have no need for any external guide in the usage of the book. Moreover, it has food plans that had been tested by a lot of people and has been discovered to has a great effect in fighting teeth diseases or gum bleeding such as gingivitis. The food plan is such that the author has used it to point out foods to eat and those to avoid. Not limited to adults, Total Dental Health is well-equipped to help children in preventing teeth problems that might later cause pain and embarrassment. With its unique natural methods, the user gets the chance to spend less as opposed to when he/she visits a dentist Read more...

Total Dental Health Summary

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Author: Mike
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Price: $7.00

Caries risk assessment

During the initial history, examination and treatment planning for every patient, it is important that there is also an assessment of the patient's individual risk of developing further carious lesions or progression of existing lesions7. This procedure is termed caries risk assessment. Assuming that all aetiological factors remain equal, this should help in identification of the main causative factors and aid with recommending specific preventive or restorative measures for that individual patient's needs. Dental management of caries may involve operative intervention, but should always incorporate preventive measures. Caries risk assessment carried out during treatment can serve as a monitoring aid for the success of treatment. This assessment should be based upon Caries experience Socio-economic status - to evaluate the patient for compliance. Caries tends to be a disease of deprivation and is more prevalent in patients with lower socio-economic status. The patient's risk of...

Stepwise caries removal

Where gross caries is present in a tooth, an assessment should be made of the likelihood of creating a carious exposure should all caries be removed. In the situation in which risk of an exposure is high, it is prudent to remove only the peripheral caries and the majority of caries on the pulpal floor. A calcium hydroxide dressing (to encourage formation of tertiary dentine and kill any remaining bacteria) and a well-sealed temporary restoration is then placed. Approximately 3 months later, re-exploration of the cavity is performed and remaining caries removed. Such an approach reduces the incidence of pulpal exposures and subsequent loss of vitality24,25.

Building the Case for Oral Health Care for Prisoners Presenting the Evidence and Calling for Justice

Note Portions of this chapter were previously published in two papers written by the same lead author as for this chapter, Henrie M. Treadwell, and are incorporated into the text of this extended essay with the permission of the publishers who hold the corresponding copyrights. The two papers are Treadwell, H. M., & Formicola, A. J. (2005). Improving the oral health of prisoners to improve overall health and well-being. American Journal of Public Health, 95(10), 1677-1678. Treadwell H. M., & Northridge, M. E. (2007). Oral health is the measure of a just society. Journal of Health Care for the Poor and Underserved, 18(1), 12-20.

Why Oral Health is a Public Health Priority

Our hope for this chapter is to place the oral health and health care needs of incarcerated populations on the table as worthy of inclusion in efforts to improve public health and public safety. While there is a plethora of pressing issues for those behind bars, absent explicit attention to their mouths, it is unlikely that their oral health and health care needs will ever be met. A recent edited volume devoted to Social Injustice and Public Health (Levy & Sidel, 2006) included a particularly thoughtful and forward-thinking chapter on incarcerated people (Drucker, 2006). Unfortunately, oral health was totally absent from the section The Health of Prisoners and, indeed, all sections in this chapter. The omission of oral health from overall health and well-being is nearly universal in the public health literature. This lapse needs to be righted if we are to ever achieve equitable health and health care for all members of U.S. society. On the other hand, the oral health community...

Building the Case for Oral Health Care

The burden of oral diseases and conditions is disproportionately borne by those of lower versus higher social standing at each stage of life (Treadwell & Northridge, under review). Poor nutrition, lack of preventive oral health care, violence leading to facial trauma, and tobacco and alcohol use affect teeth and their supporting structures, leading to dental caries (beginning in early childhood and continuing throughout the life course), periodontal diseases and tooth loss (especially in adults), and oral and pharyngeal cancers (predominantly disorders of the elderly) (Northridge & Lamster, 2004). Furthermore, research is currently underway to understand the relationship between peri-odontal infections in mothers and preterm low birth weights of their babies (Mitchell-Lewis, Engebretson, Chen, Lamster, & Papapanou, 2001), which suggests that there may be intergenerational effects of oral diseases. The Surgeon's General report Oral Health in America went beyond health to document the...

Caries prevention

A decision to intervene in the management of dental caries is probably one of the most important decisions a dentist will make. Early restorative intervention should be avoided if possible as tooth preparation is irreversible and commits the tooth to the restorative cycle8. All restorations fail at some time and require either repair refurbishment or replacement, resulting in yet another insult to the tooth tissues. This repeated insult can ultimately lead to the loss of the tooth. A delayed start on this cycle is advised wherever possible, and there is a resurge in providing early preventive and remineralisation treatment and minimal intervention of carious lesions8. Fluoride supplements can be either patient or dentist applied. The effects of fluoride on caries in different sites are variable10. Fluoride has produced the following reductions in caries 20 in occlusal caries 55 in interproximal caries 61 in smooth surface caries It is clear that occlusal caries will still be a...

Removal of caries

With access established, caries is removed, first from around the amelodentinal junction and then, working apically, towards the areas overlying the pulp. When caries extends down to a vital pulp, one should aim to remove all soft, stained, infected dentine leaving either some stained but firm dentine or possibly some slightly softened, unstained dentine protecting the pulp from exposure. The rationale for this is that affected dentine (rather than infected dentine) may be retained and remineralised with the use of a therapeutic liner. It is common to experience difficulties in distinguishing between dentine that should be removed, and that which should be left. Fluorescence-aided caries excavation5 or a caries detector dye have been suggested as aids in such situations, but may actually lead to over-preparation6. The area of the amelodentinal junction must always be made completely caries-free, although again the necessity for this has recently been questioned.

Oral Health

Oral health is an important part of overall health and self-esteem. In a review by Treadwell and Formicola (2005), no data were found on the oral health needs of incarcerated juveniles. However, in the general population, 80 of tooth decay occurs among 25 of children 5-17 years of age, primarily in minority and low-income families and in children with low educational levels. These are the children who are disproportionately represented in juvenile justice facilities. For incarcerated adolescents, there are few preventive services and often failure to access dental services, even when covered by Medicaid.

Ergonomics In Dentistry

This transformation began with the general adoption of a comfortable, supported and seated position for the operator and the consequent supine positioning of the patient. However, the necessary changes in posture and working procedures were largely overlooked and, despite the convincing work and publication of Paul1, it would seem that many dentists persist in working in inefficient, distorted postures that must frequently lead to excessive fatigue if not skeletal damage.

Drug Delivery to the Oral Cavity or Mouth

Caries, or tooth decay, is the most common disease of the teeth among humans. Tooth decay originates in the build-up of a yellowish film called plaque on teeth, which tends to harbour bacteria. The bacteria that live on plaque ferment the sugar and starchy-food debris found there into acids that destroy the tooth's enamel and dentine by removing the calcium and other minerals from them. Alkali production from urea by bacterial ureases in the oral cavity is thought to have a major impact on oral health and on the physiology and ecology of oral bacteria1. Another common dental disorder is inflammation of the gum, or gingivitis. It usually commences at or close to the gum margin, often between adjacent teeth. Pockets form between the gum and the adjacent teeth, sometimes penetrating deeply into the tissues. This leads to further infection, with inflammation and bleeding from the infected gums. A principal cause of gingivitis is the build-up of plaque on teeth, which causes irritation of...

Preservative Management

Over recent years the dental profession has shifted towards practising preventive dentistry and adopting more conservative and tooth-preserving procedures. Such progression is considered to be a response to the decline in the level of dental caries and increased consumer demands with regards to comfort of treatment and advances in materials science. This shift in caries management, based on rational clinical and scientific principles, will no doubt continue over the coming decades1.

Principles Of Operative Intervention

Modern cavity preparation and design and the evolution thereof cannot, or perhaps should not, be considered without reference to G.V. Black. Black's text A Work on Operative Dentistry in 19082 was the first to prescribe a systematic method of cavity preparation and the 'ideal' cavity form. These features relate to the instruments available at the time (slowly rotating burs with poor cutting efficiency and chisels), caries incidence and pattern, as well as restorative materials available. Although modifications to the classical cavity forms and principles to achieve these were suggested in the early 1900s, these principles remained appropriate and largely unchallenged for a period of over 50 years. The basic shape, and some of the ideals, of Black's cavities have been popular until recent times and indeed to a degree are still prevalent. In contrast to Black's principles of cavity preparation, which included the establishment of outline form including extension for prevention, the...

Development of final form

Once the caries has been removed, before proceeding to create the final cavity form, it is necessary to consider the biological, functional and mechanical demands that will be placed on the final tooth-restorative 'system'. In particular, the following should be considered. The preparation should be planned to maximise the preservation and protection of remaining tooth structure. Increasing cavity depth and width increases the potential for outward flexion of buccal and lingual walls7. Preparations with a curved floor show less cuspal movement than those with a flat floor and a flat floor with its sharp angles and stress concentrations may lead to fracture. This flexure may also have effects on subsequent buccal restorations8. If caries has undermined the remaining tooth structure to a significant degree, the tooth may fracture during function. The planned removal of such healthy tissue may, in fact, preserve tooth structure in the long term Black originally proposed that margins...

Infections Caused By Nonphaemolytic Streptococci

Since many of these streptococci are present in the mouth, upper respiratory tract, genitourinary tract and, to a lesser extent, gastrointestinal tract, they are sometimes involved in pathological processes at these sites, possibly following some local or systemic change in host susceptibility or an alteration in local environmental conditions. A classic example is the manifestation of dental caries that arises following excessive consumption of dietary sugars, particularly sucrose. Alternatively, the streptococci at a mucosal site may gain access to the blood stream because of some local traumatic event and set up an infection at a distant location, such as the heart valve in endocarditis or in the brain or liver, giving rise to an abscess. The key event for infections at distant body sites is bacteraemia.

Preliminary radiographs

The radiograph should be carefully examined in a systematic manner. Reference should be made to adjacent anatomical structures, the condition of the surrounding bone and associated periodontal ligament space. The anatomy of the pulp chamber and root canals should be examined, details regarding the presence of caries, features of the coronal restoration, number and anatomy of the roots being particularly important. It must be remembered that a radiograph is only a two dimensional representation of a three-dimensional object and although roots may appear to have mesial or distal curves, they are also likely to curve in buccal or lingual directions. Magnification aids will assist interpretation of the radiograph.

A fl D AflILMLD Ail A A

These initial clinical studies demonstrate that topically applied antiS. mutans SlgA plantibody (CaroRx) is safe (no HAMA, no local or systemic toxicity) and prevents colonization by S. mutans, the major cause of human dental caries (Ma et al., 1998). Planet Biotechnology, Inc., has submitted an IND (investigational new drug application) to the U.S. Food and Drug Administration (FDA) and phase I II confirmatory clinical trials began at the School of Dentistry at the University of California in San Francisco in Autumn 1998.

Limitations Of Indirect Restorations

Indirect restorations typically have a longer lifespan than similar direct restorations27. However, it is a common misconception that once an indirect restoration is placed then the tooth does not require any care. In fact, the opposite is true. Any indirect restoration will have a 'long' margin that is essentially its weak point with respect to caries. It is not uncommon for caries to progress rapidly along the margins of a restoration such as a crown and for this caries to go unnoticed for some time. Caries at the margins of indirect restorations is often not detected until it has progressed so far as to make further restoration of the tooth questionable at best, and often impossible. It is essential that follow-up and maintenance are provided for any restoration and especially for indirect restorations.

Recognition of failure

Most marginal defects are directly observable. In addition to clinical examination, radiographs are a useful adjunct to identify interproximal marginal defects deficiencies or caries that may otherwise go unnoticed10. Also given the incidence of loss of vitality of teeth with indirect restorations, especially long-term11, periapical radiographs may be useful to detect peri-radicular pathology.

Replacement And Repair Of Restorations

In recent years there has been a shift towards maintenance and repair15, rather than the replacement of the deteriorating yet serviceable restorations in patients who maintain a good standard of oral hygiene. These patients with favourable oral environment and low caries risk should receive minimum intervention. As a clinician, one must be able to

Relationships Diagram

Initiators are professionals with legal authority to prescribe a needed regimen. Examples are general practice, primary care, and specialist physicians physician's assistants clinical nurse practitioners dentists podiatrists and pharmacists, for OTC medications or who have prescribing authority.

Recommendations and Conclusions

In closing, we have adapted the following core set of recommendations from the report titled, Confronting Confinement A Report of the Commission on Safety and Abuse in America's Prisons (Gibbons & Katzanbach, 2006) to explicitly refer to improving the oral health care of imprisoned populations. 1. Partner with oral health care providers from the community. Departments of corrections and oral health providers from the community should join together in the common project of delivering high-quality oral health care. 2. Build real partnerships within facilities. Corrections administrators and officers must develop collaborative working relationships with individuals and organizations that provide oral health care to prisoners. 3. Commit to caring for persons with oral health problems and providing them with culturally competent oral health care. Legislators and executive branch officials, including corrections administrators, need to commit adequate resources to identify prisoners with...

Noninfectious Diseases

Adjust with time to those observed in the local population (Kliever, 1992). Thus, epidemiological data on migrants should be integrated in a dynamic way, as their migratory journey evolves. Doctors should also look at the short-and long-term effects of protein or vitamin deficiencies leading to osteomalacia and bone deformation, iron deficiency and anaemia. Anaemia can result also from genetic traits, such as glucose-6-phosphate dehydrogenase deficiency or thalassaemia. Both are quite common in ethnic minorities in England 3-10 in Indians, 10-14 in Afro-Caribbeans, 20-25 in West Africans (Modell and Modell, 1990). Oral health is often a forgotten problem of particular concern in children, who may show a high proportion of dental carries, with long-term consequences.

Etiology And Pathogenesis

Elimination of preexisting dental periapical, periodontal, and mucosal infections, institution of comprehensive oral hygiene protocols during therapy, and reduction of other factors that may compromise oral mucosal integrity (e.g., physical trauma to oral tissues) can help reduce the frequency and severity of oral complications in cancer patients. Such complications can be acute (developing during therapy) or chronic (developing months to years after therapy). Radiation is not only associated with acute oral toxicities, but may also induce permanent tissue damage leading to multiple life-long risks of tooth decay, infection, and ORN among others. Multiple prospective studies have demonstrated increased acute toxicities with the addition of chemotherapy to radiation,14-16 particularly when administered concurrently. However, the contribution of chemotherapy to the late toxicity profile post-RT is in need of further study. The risk of dental cavities increases secondary to a number of...

Complications of Radioiodine Treatment

The salivary glands accumulate radioiodine and are thereby prone to damage. Salivary dysfunction (xerostomia and sialadenitis) following radioiodine may occur in up to a third of patients and is related to the cumulative activity of 131I administered 92 . Acute sialadenitis affecting the parotid or submandibular salivary glands occurs within 48 hours of administration and may last for a few days but may be protracted. This is more commonly seen with higher administered activities. Chronic symptoms include recurrent salivary tenderness, swelling, dry mouth, and altered (metallic or chemical) taste sensation 93 .Lack of saliva can result in dental caries and teeth may require extraction (Figure 15.6). Several studies have quantified salivary damage by technetium scintigraphy and shown a direct relationship between administered cumulative radioiodine dose and severity of salivary gland dysfunction 92 . Figure 15.6 Dental caries multiple radioiodine treatments resulted in severe...

Improving Public Health Through Correctional Health Care

Section Three is about primary and secondary prevention. What can we do to prevent disease in the first place and how can we devise programs for early detection (screening) and treatment, using evidence-based protocols How do we prevent suicides How can we improve the diagnosis of mental illness Why is oral health care important How are women's health issues different from men's health issues How are youth different from adults behind bars

Case Presentation

A B The molar exhibits poor prosthetic treatment (overhanging crown margins, secondary caries) and apparent partial filling of the coronal pulp chamber. C D The caries was removed, the crown margins were properly adapted, and the root canals were reinstrumented and then rinsed with NaOCl and Chlorhexamed.

Presenting the Evidence

Dental care is listed as an essential health service by the National Commission on Correctional Health Care (Treadwell & Formicola, 2005). Nonetheless, the oral health status of prisoners is overridingly poor. As with other individuals of low social standing in the U.S. population, adults who are incarcerated in both federal and state prison systems are more likely to have extensive caries and periodontal disease, be missing teeth at every age, and endure a higher percentage of unmet dental needs than employed U.S. adults (Mixson, Eplee, Feil, Jones, & Rico, 1990 Salive, Carolla, & Brewer, 1989). Clare (1998) conducted a survey of dental decay, moderate periodontal pocket depth, and urgent treatment needs in a sample of adult felon admissions and found more unmet dental needs in the prison sample compared to those reported among participants in Phase One of the Third National Health and Nutrition Examination Survey (NHANES III). Clare (1998) hypothesized that a possible cause for the...

Biographies Of Briggs And Shantz

He shared the Magellan medal with Paul R. Heyl in 1922, received the Medal of Merit in 1948, and the Gold Medal of the U.S. Department of Commerce for exceptional service. He was an honorary Fellow of the American College of Dentists a Fellow of the American Association for the Advancement of Science a Fellow of the American Physical Society (and its vice president in 1937 and president in 1938). He was a member of the National Academy of Sciences American Society of Mechanical Engineers Washington Academy of Science (its president in 1917) Philosophical Society of Washington (its president in 1916) American Philosophical Society American Academy of Arts and Sciences Institute of Aeronautical Science Newcomen Society (engineering society) Washington Academy of Medicine (its president, 1945-1946) and an honorary member of the Physical Society of Engineering. He was a member of Tau Beta Pi, Sigma Xi, and Sigma Pi Sigma (Debus, 1968).

Acquired abnormality of cobalamin metabolism nitrous oxide inhalation

Nitrous oxide irreversibly oxidizes methyl cobalamin from its active, fully reduced CobI state to an inactive precursor with the CobII state. This has been shown to inactivate methylcobalamin and methionine synthase. This occurs in both humans and experimental animals and is of importance in the megaloblastic anaemia that occurs in patients undergoing prolonged N2O anaesthesia (e.g. in intensive care units). A neuropathy resembling cobalamin neuropathy has been described in dentists and anaesthetists who are repeatedly exposed to N2O and in monkeys exposed to the gas for many months. In patients with low cobalamin stores, megaloblastic anaemia or cobalamin neuropathy may be precipitated after shorter exposure to N2O. Recovery from N2O exposure requires regeneration of methionine synthase, as this protein is damaged by active oxygen derived from the N2O-cobalamin reaction. Methylmalonic aciduria does not occur at first as ado-cobalamin is not inactivated by N2O. Later, however, after...

Repair Of Teeth And Periodontium

There are no dental restorative materials that have the same physical and chemical characteristics of natural tooth tissues. The success rate of using such materials to repair teeth in which the pulp has been exposed is very low, which means that dentists will commonly recommend either a root canal (pulpotomy) or extraction of the tooth. To fill even tiny early cavities, a disproportionate amount of enamel must be drilled out in order to insure adhesion of the resins or metal alloys currently used as restorative materials. However, a paste of modified hydroxyapatite (the inorganic component of bone matrix) has recently been developed that can be applied to microcavities without drilling and which integrates perfectly into the enamel (Yamagishi et al., 2005). This material has high durability and acid tolerance.

Patient position

Dentistry to any other precision activity by a seated operator and describes the 'home position' in which the objective is raised to the mid-sternal position and the head tilted forward to observe the fingers. Most dentists will gradually adopt this position by trial and error and indeed many will programme the dental chair to return and permit this situation for every patient (Fig. 1.4).

Gaining access

In order to remove caries, create the required form of preparation, and enable restorative materials to be placed, adapted and contoured to restore form and function, it is generally necessary initially to cut through and then cut away part of the enamel of the tooth to be treated. Even when the tooth contains a large lesion, it is generally necessary to gain access using a friction-retained, water-cooled, diamond bur held in an air turbine handpiece. If the lesion to be treated is associated with an existing restoration, the whole restoration may need to be removed using the air-turbine handpiece however, increasingly the benefits of repairing rather than replacing existing restorations are being acknowledged.

Sonic preparation

Sonic instruments have been used within the field of dentistry for many decades, principally for scaling and root surface debridement. Their use for cavity preparation has been revisited recently. The system was initially marketed for proximal lesions with matching size preparation tips and ceramic inserts. This type of approach proved to be destructive to the tooth tissue. The newer sonic handpieces allow for interchangeable tips and multiple applications, such as minimally invasive caries therapy, cavity preparations, endodontics, periodontics, luting procedures and prophylaxis.

Air abrasion

Air abrasion has also been revisited in recent years in light of developments in restorative materials and changes in cavity preparation design. Most units work by delivery of a jet of aluminium oxide particles at a pressure of 40-149 psi (276-1028 kPa) through a fine nozzle. It is these spray particles that effectively cut the tooth tissue and restorative materials. Air abrasion is best suited to the treatment of small lesions in pits and fissures, cervical caries and recurrent caries around existing restorations. The advantages of such a system include a local anaesthetic is usually not required several lesions in different quadrants can be completed at one visit saucer-shaped preparations can be produced and these are ideal for resin-bonded restorations and there is less noise and vibration compared with the slow handpiece. However, over-spray can contaminate the surgery, clog the handpiece bearings, block the suction units and damage unprotected adjacent teeth. It is claimed that...

Historical concepts

Microleakage is the term used for the passing of fluids, microorganisms or ions between the restoration and the adjacent preparation walls. Microleakage occurs around all restorations currently used in restorative dentistry, including those that are adhesively bonded to enamel and dentine. Such leakage provides a path for the ingress of bacteria and their products around restorations and has been implicated in a variety of clinical conditions, including marginal discoloration, pulpal irritation and subsequent necrosis, postoperative sensitivity, recurrent caries and eventual failure of restorations15,16.

Pulp capping

Greater understanding of the caries process has led to the distinction between infected and affected dentine26. Stained dentine may be affected by caries (may be slightly demineralised or conversely may be sclerosed) but may not necessarily be infected and thus removal of such dentine would, in fact, be over preparation with unnecessary loss of tooth structure. Thus it could be argued that the first definition Although several studies have been completed with regard to progression of caries and prognosis of teeth in which permanent restorations are placed over caries, there is at present insufficient evidence to support this approach. Thus the second approach to indirect pulp capping (where soft, carious dentine is left) describes a procedure that, with current evidence, should not be performed. For stepwise caries removal (to encourage formation of tertiary dentine, kill any remaining bacteria and reduce risk of exposure).


Given the routine use of bonding agents with polymeric restorative materials, the additional use of dentine pins with these materials is questionable as the disadvantages would seem to outweigh any advantages. In addition if an adhesively retained restoration is supplemented with dentine pin placement, catastrophic bond failure may go unnoticed and rapidly progressing caries is then a risk.

Benefitrisk Analysis

Usually, however, the clinical trialist has to stick out his her neck, based upon an highly personal, non-numerical assessment of benefit-risk. The highly mathematical approaches usually work best in retrospect, and this is not the situation of the clinician who must decide whether to prescribe, or the clinical trialist who must decide whether to commit patients to a particular study design, both being prospective decisions. Furthermore, both in clinical trials and general medical practice, it is a rare situation where the benefit to the patient arises from a single binary variable, and there are no drugs which possess a single type of adverse event, whose probability may be confidently, pro-spectively estimated for any given patient. Even the simplest case, a drug with substantial history and experience, cannot fit the contrived mathematical approach described above. Penicillin has three adverse events of primary interest (anaphylaxis, bacterial drug resistance, and sodium load at...

Posterior teeth

Axial stress placed on any restoration distal to the canines. The preparation of the access cavity and removal of the roof of the pulp chamber acts to increase the stresses at the base of the cusps during function and predisposes these cusps to fracture. In addition, in most root-filled posterior teeth, removal of caries and defective restorations will have resulted in disruption of the marginal ridge, which further weakens the tooth. The overall result of this is that the compromised cuspal tissue cannot withstand the 'wedging' forces developed during function and is liable to fracture13. Teeth requiring endodontic treatment have typically lost tooth structure (due to previous restorations and or current caries) further loss of coronal dentine is necessary for endodontic access. As a result, there is often a lack of coronal dentine in which to prepare retentive features without compromising the strength of the remaining tooth structure. Nayyar and his co-workers described a technique...


The perception by industry of the huge potential market spurred on marketing and advertising unprecedented with other lasers. The whole direction of cutaneous laser surgery shifted dramatically from a medical-scientific discipline to a medical-industrial commercial one (338). Courses were now driven not by medical interest in academic settings but by almost weekly promotional courses directly by laser companies using guest laser lecturers. Roving laser rental companies first appeared with a have laser (and technician), will travel motto. In-hospital laser peer credentialling became a practical though not a moral irrelevancy. The early 1990s saw a new federal administration with health care as its priority and fostering HMOs as its club to beat down costs. In 1992 Medicare law drastically cut physician reimbursements. With the appearance of safe cosmetic laser surgery as an alternative for diminished income, not only traditional cutaneous surgeons (dermatologists, otolaryngologists,...


Whenever any restorative intervention has been undertaken, there is an implication that disease (caries) or mechanical failure has occurred. To place a restoration without considering these factors will expose the restoration to an uncontrolled and unstable environment with an increased likelihood of failure. A correct diagnosis is essential before any treatment and in all cases, aetiological factors should be controlled as much as is possible. For example, if mechanical failure has presented as multiple fractures of teeth or restorations, provision of an occlusal splint to control and distribute the excessive occlusal forces would be of benefit. Similarly, where failure is due to recurrent caries or there is a high caries risk, the importance of regular exposure to fluoride should be remembered and appropriate fluoride supplements (e.g. mouthwash) should be advised.

Management decision

Although a fault may be identified, operative interference may not be warranted. A minor defect of a restoration margin with no signs of caries due to microleakage is a serviceable restoration. All operative interventions carry risk of additional damage to remaining natural tissues and intervening in a situation such as this will result in unwarranted removal of healthy tooth structure. Where minor defects have occurred, it is often possible to adjust local features and avoid radical When a fault is present but is localised to one region of the restoration, then consideration should be given to repairing rather than replacing the restoration, such that the intervention is minimised. Similarly, when caries is present adjacent to a restoration margin, then considering the lesion as a new primary lesion and providing a localised repair will also act to preserve the health of the tooth. Although evidence for survival of repaired restorations is sparse, there are reports of good short-term...

Calling for Justice

The oral health status of inmates in the prison system is not routinely incorporated into data and reports that summarize the state of the nation's health. Yet the number of imprisoned citizens is already high and further increases are expected if current drug and incarceration policies remain in place (Drucker, To help people be all that they can be, we must pay attention to their entire well-being. Because oral health is inextricably linked to overall health, as well as to self-esteem, we have a responsibility to ensure that oral health services are available and accessible as part of our health care delivery systems both within and outside prison walls. If good oral health care is provided to prisoners, the benefits will extend to their families, their communities, and the nation as a whole. What can we do as a society to better ensure improved oral health and health care for incarcerated populations


It has been shown that bacterial infection is a prerequisite for internal resorption4. This process seems to be elicited by irritation from bacteria or their products within the dental tubules derived from caries, fractures or anatomical defects. Sometimes, resorptive defects are noted radiographically in root-filled teeth and this may be attributed to percolation of oral fluids via a defective coronal restoration or periodontal pocket and lateral canals etc. When seen radiographically, internal resorption is a definite indication that endodontic treatment is required. Clinically, there is necrosis in the pulp chamber and in the root canal to a level coronal to the resorption lacunae. Root treatment is complicated by the problems associated with removal of tissue from a resorptive defect and any remnants may contribute to failure. The treatment of choice is to use sodium hypochlorite as an irrigant and to dress the canal with calcium hydroxide paste, replacing at 2-3-week intervals...

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